Case Management Program Reduce Opioid Overuse

A poster out of AMCP 2021 showed that an opioid case management program effectively reduced opioid overuse by enhancing care coordination.

Tiffany Del Rosario, PharmD, BCGP, of Scan Health Plan and colleagues presented the data of their retrospective review, which enrolled their health plan members with certain patterns into the Reduce Overuse and Misuse (ROAM) opioid case management program. Enrolled members included those with multiple or high-dose opioids, multiple opioid prescribers, and opioid dispensing pharmacies, and/or multiple emergency room visits related to pain.

ROAM uses an interdisciplinary team that contributes to the goal of enhancing care coordination so that one prescriber or pain management group is managing the member’s pain. In the program, the pharmacist, care managers, fraud investigators, and physician are all assigned certain team responsibilities.

“Pain is a common problem among older adults, and many are prescribed opioid pain medication,” Del Rosario said. “Opioids are effective at treating specific types of pain, but they do carry serious risks such as the development of opioid use disorders, overdose, and death. These risks can be increase with overuse, which can stem from a highly fragmented health care system.”

In an evaluation of ROAM, Del Rosario and colleagues measured change from 2013 to 2019 in opioid count, average daily morphine milligram equivalent dose (MME), opioid prescribed count, opioid dispensing pharmacy count, and number of emergency room visits.

During the study period, 83 members were enrolled in ROAM. About half had an average MME dose of 50 or greater. Prior to case management, 22% were on opioids for less than one year, 53% were on opioids for 1 to 3 years, and 25% were on opioids for 3 years or longer.

The researchers compared the 3 months pre- and post-case management and found a significant 39% decrease in the count of unique opioid claims per member per month (P<0.001). Forty-eight percent of members with an MME of 50 or greater prior to ROAM had an MME less than 50 after (P=0.023).  Additionally, there was a 55% decrease in the average number of opioid prescribers per member (P<0.001) and a 35% decrease in the average number of opioid dispensing pharmacies used per member (P<0.001). The proportion of members with emergency room visits related to pain decreased by 39% (P=0.02).

“Our study confirmed that our opioid case management program did effectively reduce overuse in our members,” Del Rosario said.

Del Rosario T, et al. The Impact of an Opioid Case Management Program on Opioid Overutilization. Poster G58. Presented at AMCP 2021; April 12-16, 2021.